Increased exposure to orally administered CYP3A4 substrates. If co-
administered with NK1 RAs, the recommended oral corticosteroid dose should
be reduced by approximately 50%. Monitor for AEs with midazolam. Monitor
for AEs with CT agents metabolised by CYP3A4; no need to adjust the dose
Efficacy of warfarin and oral contraceptives may be decreased.
Co-administration of aprepitant with active substances that are metabolised
by CYP2C9 (for example phenytoin, warfarin) may result in lower plasma
concentrations of these active substances. Monitor INR. Additional
contraception is needed for two months
Rolapitant is an inhibitor of BCRP. Increased plasma concentrations of BCRP
substrates (for example methotrexate, irinotecan, topotecan, mitoxantrone,
rosuvastatin, sulfasalazine, doxorubicin, bendamustine) may result in potential
adverse reactions. Potential for increased exposure: monitor for AEs with
substrates of CYP2D6and P-gp (for example, digoxin). No need to reduce the
dose of dexamethasone. CYP2D6 participates in the metabolism of all 5-HT3
RAs, except granisetron
Possibly increased likelihood of olanzapine AEs. Dose reduction of olanzapine
by 25% might be required
Possible decrease in efficacy of olanzapine. Monitor the occurrence of nausea
and vomiting
Reduced bioavailability of olanzapine (only activated charcoal) and
corticosteroids. Separate administration by at least 2 h
QTc interval prolongation and arrhythmias may occur. Caution is required in
patients with cardiac comorbidities or with QTc prolonging drugs
Possible occurrence of serotonin syndrome. Avoid interaction when possible
Possibly reduced efficacy of tramadol
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